Provider Demographics
NPI:1043325665
Name:FENNELL, MEREDITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:FENNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:2016 CHICORA RD
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-0375
Mailing Address - Country:US
Mailing Address - Phone:724-445-2558
Mailing Address - Fax:724-445-3705
Practice Address - Street 1:2016 CHICORA RD
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025
Practice Address - Country:US
Practice Address - Phone:724-445-2558
Practice Address - Fax:724-445-3705
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist